Cognitive Test Trump Took May Have Been Undermined by Publicity, Doctors Warn

Posted July 16, 2018 4:57 p.m. EDT

By Niraj Chokshi, New York Times

Six months after a White House physician told reporters that President Donald Trump had aced a well-regarded test of cognitive impairment, a group of doctors is warning that the exam may have been compromised by the resulting news coverage, which revealed some of its questions.

Until it’s clear what effect the exposure has had on the effectiveness of the test, known as the Montreal Cognitive Assessment, or MoCA, doctors should consider using alternatives, said Dr. Hourmazd Haghbayan, an internist at the University of Toronto.

“When I saw that this test was being disseminated to the mass population, and in some cases individuals were being invited to take it online, I wondered whether there would be an effect,” Haghbayan and colleagues wrote in a letter published Monday in the medical journal JAMA Neurology.

The group collected data to show how widely the test’s questions were publicized after Dr. Ronny L. Jackson, a rear admiral in the Navy and then the White House physician, mentioned it at a news conference in January.

Jackson, who later withdrew as nominee for Veterans Affairs secretary under a cloud of scandal, told reporters at the time that Trump was in “excellent” overall health and that he had landed a perfect MoCA score.

“The fact that the president got 30 out of 30 on that exam, I think that there’s no indication whatsoever that he has any cognitive issues,” Jackson said.

Trump has long faced questions about his mental stability and his fitness for office. He has occasionally responded to them directly, as he did in early January when he described himself on Twitter as “a very stable genius.”

Using a Google News search, the researchers found 190 articles published in the days after the announcement that mentioned MoCA in reference to the president.

Of those, more than half published several exam questions — including an article by The Times — while 84 presented readers with the full test, either presenting it in the body of the article or linking to it. All of the articles referred to a single variant of the test, Version 1.

Search interest for MoCA spiked at the time. But the effect of the news coverage may have outlasted that news cycle, the researchers said.

“Given ongoing interest in age-associated cognitive function, public awareness of specific cognitive tests, such as the MoCA, may continue to increase,” they wrote. “It is possible that the MoCA’s applicability may be compromised in individuals exposed to its contents via such mainstream media reporting.”

MoCA has gained acceptance as a quick and easy way to screen for general cognitive impairment and is used at Walter Reed, all 31 of the National Institute on Aging’s Alzheimer Disease Centers, and other hospitals. It involves asking patients to repeat words, identify pictures of animals and draw clocks set to a specific time.

Doctors have several other methods of assessing cognitive impairment, including alternative versions of MoCA itself, said Haghbayan, who acknowledged that the letter could bring even more attention to the test.

“It’s all a balance of informing the public,” he said, adding that “it would be best to report on it in a more general sense.”